Transcript Network Meeting Clinical Uses of Assessment Measures

Clinical Uses of Assessment Measures
The Chadwick Center for Children & Families
Nicole Taylor, Ph.D.
Robyn Igelman, M.A.
Objectives
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5.
6.
Designing an assessment protocol
Capturing the Data
Getting staff buy-in
Providing clinicians with assessment results
Using the data clinically
Other uses of assessment data
THE CHADWICK CENTER’S ASSESSMENT and OUTCOME HISTORY
Example of Phases in Protocol
Development
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Idea is Proposed
Consultation/Brainstorming
Initial Protocol Developed
Pilot Program
Program implemented with therapists
Troubleshooting and Refining process
Steps to Take
in Designing an Assessment Program:
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2.
3.
4.
Introduce idea and elicit support from ALL levels.
Form an assessment committee with representatives from each
level.
Make preliminary decisions regarding measures and procedures.
Properly train therapists to administer & interpret measures.
Steps to Take (cont.):
5.
6.
7.
Pilot measures and protocol on a sample population.
Be prepared to change as needs change and obstacles arise.
Remain committed.
Current Outcome Assessment Protocol
• Clients assigned to therapists
• Therapists collect all measures within first 3 visits and submit for data
entry
• Data entered, measures scored and assessment summary given to
therapists
• Measures collected by independent interviewer at six-month follow-up
intervals
• Data entered, measures scored and assessment summary given to
therapist, including data from all past assessments
• Quarterly and annual aggregate statistics compiled
Commonly Used Assessment Measures
Domain
Informants
Child
Parent
Gen. Beh.Problems
YSR, CDI
CBCL
Abuse Specific
TSCC
CSBI, CDC
TSCYC
Expectation/Satisf.
EXP, SAT
EXP, SAT
Family Fxing
FRI, FAM-III
FRI, FAM-III
Parent Fxing
Clinician
Therapist Follow-up
CES-D
YSR – Youth Self Report; CDI – Children’s Depression Inventory; CBCL – Child Behavior
Checklist; CSBI-Child Sexual Behavior Inventory; CDC – Child Dissociative Checklist; FRI –
Family Relationship Index; FAM-III Family Assessment Measure III; CES-D – Center for
Epidemiological Studies on Depression, TSCYC- Trauma Symptom Checklist for Young
Children
Administration of measures:
• Don’t:
• Do:
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Properly introduce the purpose &
benefit
Assess reading level prior to
administration
Schedule adequate time for
completion
Provide a quiet environment
Stay in the room
Encourage the client to complete all
items
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Send measures home
Provide explanations of items (refer to
manual)
Overlook missing items or incomplete
measures
Forget to check critical items!
Data Management
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DO
Establish an alliance with a
reputable University professor
Invest in a database designer
Set team goals for follow-ups
Design protocol to handle special
populations/ circumstances
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DON’T
Try to “wing it” if it is beyond your
expertise
Accept sloppy, invalid, measures
Ignore uncompleted follow-ups
Give up
Working with therapists:
Guiding the assessment and providing feedback.
Guiding Therapists via Assessment
Pathways integrated into assessment measures
Critical Items
Symptom
Change
Over Time
How to make sense of assessment results
AKA –I’m just a clinician – I don’t get this mumbo jumbo…
How to make sense of
assessment results:
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Know what each measure assesses and applicable populations
Have a general understanding of each subscale
Examine the validity scales (if any)
Use assessment results as an adjunct to your clinical interview
Clarify inconsistencies between assessment results and clinical
impressions
How to make sense of assessment
results (cont.):
• Involve the parents and children in your interpretive process
• Integrate results with clinical impressions & think about how the
results can be used to plan treatment
• Don’t discount your clinical judgment!!
How do you provide feedback to your clients?
4 Phases of Providing Feedback:
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Re-establishing rapport
Communicating assessment results
Discussing recommendations and treatment plans
Terminating the session
Jerome Sattler, 2002
Parent and client feedback:
Dos & Don’ts
DO:
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Allow one therapy session to discuss results and give feedback
Elicit client feedback and impressions regarding assessment results
Discuss results with parent and child to confirm clinical impressions
Address areas of concern not initially revealed through clinical interview
Most important: Engage them in the process!
Parent and client feedback:
Dos & Don’ts (cont.)
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DON’T:
Avoid discussing results with your clients
Act like the assessments are a waste of time (because your clients will too)
Be afraid to share written feedback and printouts with parents and children
Underestimate the ability of your clients to understand and appreciate your
feedback
How clinicians integrate assessment into treatment planning
Treatment Planning:
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Confirm & enhance initial assessment
Identify high risk clients
Identify salient symptoms
Assess changes in symptoms over time
Establish treatment goals
– Involve parents in treatment planning and goal setting, based on
assessment results
Determining Interventions:
• Identify interventions with a sound theoretical basis and strong
empirical support
• Select interventions that will address the highest priority
symptoms first
• Utilize the treatment methods most effective for treating the
symptoms you wish to target
Problem Solving: What Happens When the Measures & Clinician Don’t
Agree?
Priorities in therapy…staying on task
Don’t lose sight of the big picture
with the daily crisis.
What clinical information can you get from a standardized
assessment battery?
Applying the Data
Initial Assessment
Child
Caretakers
Engage Child
Engage Caretaker
Mental Health Providers
Assess Expectations
Assess Expectations
Legal System
Establish Treatment Goals
Assess Family Needs
Further Funding
Track Progress
Parent Treatment
Family Support Services
School
Other Agencies
How Outcome Data Helps: 10yo Sexually Abused Female
PROBLEM:
• Establishing need for therapy
• Involving child in therapy
• Resolving discrepancy between
child & caretaker report of
symptoms
USE OF DATA:
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Significant Child-Reported Symptoms
found
Explore Test Findings together to
Validate Child’s Perceptions of
Problems
Data supported the need for the
caretakers to increase their
understanding of their daughter’s
needs
How Outcome Data Helps:
10yo Sexually Abused Female
(Cont.)
PROBLEM:
USE OF DATA:
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Normalized her experience
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Confirmed therapist concerns;
Reinforced urgency and need for
safety plan and family involvement
Data helped therapist develop a
treatment plan to target existing
symptoms
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Client avoided discussing feelings
due to shame
Suicidal ideation emerged midtreatment
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Elevations on specific scales:
sexual concerns
How Do You Track Progress
Over Time?
Other Uses of Data:
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Provide clinicians within aggregate information on client base
Identifying holes in referral base
Identify center deficiencies in terms of meeting client needs
Research
Develop clinical pathways
Reasons for Seeking Treatment by Year
70%
60%
50%
40%
30%
20%
10%
0%
Molest
DV
Neglect
Sibling
1995
1997
1999
Physical abuse as a reason for referral
consistently occurs between 21%-22%
Referral Source by Year
40%
30%
CPS
Evidentiary
Self
School
20%
10%
0%
1995
1997
1999
Health care provider consistently
refers 4%-5% of population
Enlisting Staff Buy-In
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DO
Enlist Feedback early and
regularly
Provide easy to read feedback
forms and trainings
Provide feedback rapidly
Be open to change based on
feedback
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DON’T
Implement a program w/o staff
input
Overload staff with measures
Ignore staff complaints
Evaluate staff based on
feedback results
Adoption is a DOING thing!
“BETTER
IDEAS”
COMMUNICATED
In a certain way
Happens
over time
Thru a SOCIAL system
Adapted from Rogers, 1995
(C) 2001, Sarah W. Fraser